Nipple-sparing Goldilocks procedures were performed under general anesthesia with perioperative antibiotics. Wise patterns were designed on the breasts undergoing mastectomy (Figure 1A). After marking a new nipple areolar complex using a cookie cutter, the area outside of this but within the Wise patterns were de-epithelialized (Figure 1B). Next, inferior based fasciocutaneous flaps were created (Figure 1C). The deep aspect of the flaps was along the mastectomy plane. These would be used to provide further coverage of the tissue expanders.
After completing the mastectomies (Figure 1D), the breast pockets were irrigated and hemostasis was obtained with Bovie electrocautery. The lateral breast borders were disinserted. Lateral thoracic fasciocutaneous flaps were advanced to the lateral border of the pectoralis major muscle and secured in place using a running PDS suture bilaterally. An appropriately sized tissue expander was selected and subsequently placed within the breast pocket. Each were secured at all 6 tabs using PDS suture. The inferior based fasciocutaneous flaps were then advanced over the expander (Figure 1E). The incisions were then closed in a similar fashion bilaterally. The T point was then approximated using PDS suture. The inframammary fold incision was closed in layers using PDS suture to first approximate the deep soft tissue. Subsequently PDS approximated the deep dermis and the skin was approximated with running Monocryl suture.
Subsequently the expander was filled partially with injectable saline ensuring good capillary refill of the overlying flap (Figure 1F).
Figure 1 can be viewed on the poster displayed in Conference Room F.